OBJECTIVE. The aim of the study is to analyze the results of practical application of endovideosurgical transaxillary access in thyroid surgery. MATERIAL AND METHODS. We performed the retrospective comparative analysis of the results of surgical treatment of thyroid diseases using traditional, Miccoli’s endovideo-assisted access, endovideosurgical transaxillary access. RESULTS. With the use of endovideosurgical transaxillary access, the best cosmetic result is achieved – the absence of a scar on the neck. The number of specific complications in the samples is not significantly different, nonspecific complications are not accompanied with functional disorders. CONCLUSION. The expediency of improving the endovideosurgical thyroid surgery from remote accesses showed demand ability and safety of the technique. The important condition for their application is the possibility of performing an operative intervention in a proper manner.

Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2 - 6 hours from the onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40 - 100 min for the Graham patch repair and 120 - 155 min for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch” group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

The authors present results of the investigation of melatonin receptors expression in lymphocytes in dynamics in 102 patients with acute pancreatitis of mild and severe form and in 50 volunteers. A correlated analysis was made between obtained results of laboratory and instrumental researches and clinical course of acute pancreatitis. The decrease of MT1 receptors expression was noted on 25% in patients with acute pancreatitis. The decline of MT2 receptors expression was observed on 40% of patients with acute severe pancreatitis and in a case of acute mild pancreatitis--on 15.5%, respectively. Values of MT1 and MT2 expression were equal between healthy volunteers. The decline of MT2 expression was a prognostic unfavourable sign. Obtained results of dynamic expression assessment of MT-receptors were presented as MT2/MT1 indices. Given index didn't change during disease, because of this, the index could be used as a prognostic development marker of destructive form of acute pancreatitis at the moment of patient's admission to hospital. Mean values of MT2/MT1 were determined for the purpose of universalization of used method (1.13 +/- 0.09 for mild form and 0.81 +/- 0.09 for severe form of acute pancreatitis, respectively).

An analysis of results of the endovenous laser coagulation combined with crossectomy was made in 170 patients with varicose veins of lower extremities (C(VI), C(II)-C(V)). Clinical and ultrasonic data were investigated during a period of 3-5 days (45 lower extremities) and followed up in 1-3 years after operation (194 lower extremities). Three years later the absence of reflux was observed in 95.9% of cases. In 51.1% of cases, 1-2 zones of parietal and segmental hemodynamical insignificant bloodstream were detected. A recanalization of the great saphenous vein along the whole length was revealed in 8 cases out of 194 (4.1%) patients. The bloodstream was provided by affluxes in the area of a shin and a wellhead afflux of the stump of the great suphenous vein. The ultrasonic picture of recanalization was similar to that observed in post-thrombophlebitic occlusion.

In connection with the development of endovideosurgical technologies, they are actively used for the treatment of organic hyperinsulinism. The robotized interventions have been applied in the last years. The experience of the laparoscopic and robotized operations performed on 7 patients with established diagnosis of organic hyperinsulinism was shown by the authors. The treatment was effective in all cases. The postoperative period was without complications in majority of patients. An acute postoperative pancreatitis with formation of acute liquid accumulation occurred in one case. This case required the performing of percutaneous puncture interventions using ultrasonics control. Thus, the application of endovideosurgical technologies was accompanied by low percent (14%) of postoperative complications.

A possibility of detection of BRAF mutation has been studied by means of polymerase chain reaction in punctate from the thyroid node with the aim of diagnostics of high-differentiated cancer on pre-operative stage. A study includes 94 patients with nodal lesions of the thyroid. According to cytological investigation of material, received by fine-needle aspiration biopsy, papillary thyroid cancer was revealed in 47 patients, follicular tumor-in 35 and nodal colloid goiter in 12 patients. In case of papillary thyroid cancer data of genetic analysis showed the following indices of sensitivity, specificity and diagnostic accuracy: 86%, 100% and 92% correspondingly. Detection of BRAF mutation could be used in pre-operative differential diagnostics of high-differentiated cancer and benign nodal lesions of the thyroid.

To assess the utility of combined detection BRAF gene mutation and Gal-3 expression from FNAB specimens in preoperative diagnostic of thyroid gland cancer. 41 patients with thyroid gland nodules were included in the study. By cytological conclusions of evaluated FNA specimens 20 patients had papillar thyroid cancer (PTC), 17 – follicular neoplasia, and 4 – nodular colloid goiter. Gal-3 expression were evaluated by flow cytometry method; BRAF gene mutation were evaluated by PCR. In our study the sensitivity of combined detection BRAF gene mutation and Gal-3 expression was 95%, specificity – 95%, diagnostic accuracy – 95%. Combined detection of BRAF gene mutation by PCR and Gal-3 expression by flow cytometry could be used in preoperative diagnostic of thyroid glad cancer.

Galectin-3 expression in fine-needle aspiration biopsies from 66 patients with thyroid Nodes (TN) was studied by flow fluorocytometry (FFC). Cytological study revealed 29 patients with papillary thyroid cancer, 31 with follicular tumour, and 6 with colloid nodular goiter. Galectin-3 expression was documented in 27 of the 29 patients with preoperative diagnosis of papillary cancer; in 25 (92.6%) of these cases diagnosis of highly differentiated cancer was confirmed histologically, the remaining 2 (7.4%) cases presented with benign thyroid disease. Two (6.9%) patients without galectin-3 expression had papillary cancer. In the group of patients with cytologically verified diagnosis of follicular tumour, galectin-3 expresion occurred in 2 with highly differentiated (papillary and follicular) thyroid cancer and in 2 with follicular and oncocytic thyroid adenoma. The remaining 27 patients with benign neoplasms did not show expression of galectin-3. Nor was it detected in 6 (100%) patients with colloid nodular goiter. Sensitivity of flow fluorocytometry for detection of galectin-3 expression in thyroid node aspirates was estimated at 93.1%, specificity 89.2%, diagnostic precision 90.9%. It is concluded that this method may be used as an additional tool for preoperative diagnosis of high-differentiated thyroid cancer.

Based on their personal experience with treatment of 118 patients the authors consider that sanitation-decompression percutaneous-transhepatic punctures of the gallbladder under US control can be used for arresting the inflammation process. The integral scales SAPS-II and POSSUM allow identification of groups of patients with high operative risk. The strategy of treatment depends on both the state of the patient and results of USI. The detection of an obturating concrement in the gallbladder neck requires punctures for decompression of the gallbladder and attempts to reestablish normal bile passage in addition to conservative therapy at early terms.

Purpose: To assess the utility of BRAFV600E mutation detection in preoperative thyroid cancer diagnostic. Material and methods: We studied 46 aspirates taken by FNA from patients with thyroid gland nodes. Thyroid tissue aspirates DNA was extracted by sorbent method. BRAF gene mutation was analyzed with primers specific for wild and mutant gen type by RT-PCR. Results: All patients were divided into three groups by cytological conclusions: colloid nodules (9), PTC (19), and suspicious for malignancy (18). In the group of patients with PTC all diagnoses were confirmed by histology, and BRAF gene mutation was detected in 15 (79%) FNAB specimens. In the group with suspicious cytological diagnosis only one patient had follicular cancer by histology and positive BRAF mutation. There were detected no BRAF mutation in 16 patients with histologically proven follicular adenoma, in 9 patients with colloid nodular goiter and in one patient with follicular cancer. Thereby, we received the following criteria valuers of method’s reliability: sensitivity – 76%, specificity – 100%, diagnostic accuracy – 89%. Conclusions: Detection of the BRAFV600E mutation may be a useful adjunct marker for preoperative diagnostic of thyroid gland cancer.